Intrusive Thoughts, OCD & Paranoia

By Kristina Randle, Ph.D., LCSW

I need help. I am plagued by near-constant intrusive thoughts of all three main types – violent, religious and sexual. It first started when I was about 17, of course it was smaller and easier to manage back then, so I just carried on with my life. I have never had it diagnosed, I am too ashamed and fearful of being ‘branded’. But I just don’t see what else it could be. I believe I have OCD and it’s getting worse and far more difficult to control. To make it much, much worse, every time I have an intrusive thought I get an overwhelming fear that I’ve said it aloud. I obsess over the idea that the people I live with have heard me and thus now see me as every bit the vile monster that I feel I have become. It drives me to the point of paranoia. I analyse every moment I’m near them, looking for signs of fear, hatred and disgust.If I don’t find any then I feel better for a while, but it’s only until I get another intrusive thought around them. If I see the slightest thing off about my interaction with them, I panic and assume the worst. When I’m quiet and I suddenly realise that I’m not thinking about it, I panic and think that I’ve said something aloud without realising and that they’ve heard me.Please tell me, is it possible for me to say my thoughts aloud without knowing I’ve done it?

It’s consumed my life, every waking moment is tainted by it. I wake up every day feeling as though I am going to have to face up to things I have not done nor would I ever do, knowing that today is going to be just the same as yesterday. It’s driving me to depression (as it has done in the past). I’m not suicidal, I absolutely want to keep on living and nothing will change that, but I want things to get better, I need them to. I just can’t contemplate living the rest of my life lonely because of this disease. I do not take medication, nor do I intend to, I simply refuse to live with the side effects associated with them. I need help, I’m trying to keep it together, but it’s hard on your own. What do you think?

A. OCD is a very treatable condition. Many treatments for OCD involve both medication and therapy. You stated that you “simply refuse to live with the side effects” of medication but you are assuming that there will be side effects. Some medications have negative side effects but others do not. It depends on the individual. Everyone experiences medication differently. What works for one person may not work for another. Among medications that commonly have side effects, many negative effects are very minor and hardly noticeable. You shouldn’t rule out medication. It could greatly decrease your symptoms and bring you immediate relief.

OCD is an anxiety disorder. Without treatment, it tends to become progressively worse. You also have correctly observed that it’s a difficult illness to treat without professional help. I would agree and recommend that you consult a mental health professional. The mental health professional will evaluate your symptoms and determine the best course of treatment. Treatment may or may not involve medication. That’s a decision you ultimately will have to make.

Two non-medication based treatments for OCD are cognitive behavioral therapy and exposure and response prevention therapy. Cognitive behavioral therapy focuses on both your thoughts and your behavior.

Exposure and response prevention therapy is a treatment that places clients in direct contact with their fears. The purpose is to habituate the client to their fears and teach them to tolerate, rather than avoid, the anxiety that arises from their fears. It might seem like a counterintuitive form of treatment but studies show that it can be highly effective for treating certain anxiety disorders.

Delaying the acquisition of professional help may mean that your OCD will progress. It’s already “consumed your life.” It’s time to consult a mental health professional. It is what’s needed. I hope you will consider my recommendation. Please take care.

Dr. Kristina Randle

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Last reviewed: By John M. Grohol, Psy.D. on 18 Nov 2013

APA Reference
Randle, K. (2013). Intrusive Thoughts, OCD & Paranoia. Psych Central. Retrieved on December 28, 2014, from http://psychcentral.com/ask-the-therapist/2013/11/18/intrusive-thoughts-ocd-paranoia/